Contact lenses give millions of people visual performance, freedom and confidence they could never attain from spectacle correction. Yet only a small proportion of eye care practitioners (11 per cent) discuss contact lenses with all their patients.1 Most (67 per cent) discuss them with those they deem suitable and one in five will only discuss them with patients if asked.1
Not surprisingly, two-thirds of those considering contact lenses do not feel well informed about contact lens wear and more still (76 per cent) want their practitioners to give them more information.2 If prompted, nearly nine in 10 (88 per cent) are interested in trialling lenses and one in three will go on to purchase.3
There is clearly potential for many more people to wear contact lenses, yet most practices don’t have a queue of patients waiting to be fitted for the first time. Product choice and parameter range have never been better; we therefore have a real opportunity to become more proactive and show our patients all the benefits contact lenses can offer.
So when the numbers don’t add up, where do we look for these future contact lens wearers? Well, we shouldn’t have to look too far!
Opportunities and patient benefits
If patients don’t initiate a contact lens discussion, is it right to assume they are simply not interested? It is far more likely that if contact lenses are never offered, patients simply believe they are not suitable candidates. Our challenge is to identify contact lens ‘considerers’ and those whose lives would be improved by contact lenses, then to help convert them into wearers.
The first time a patient experiences clear vision without their spectacles is a life-changing moment. We can all remember those patients who have had that ‘wow’ moment in the chair. Do all our patients deserve that opportunity? The answer should surely be yes. For this reason it is imperative to ensure we are not influenced by our own perceived barriers and decide, on behalf of our patients, whether they would be interested in contact lenses or not.
Make a note of three types of patient to whom you would not currently recommend contact lenses. After reading this article, review whether your attitude has changed.
Remember to think of your patients as potential contact lens and spectacle wearers, rather than one or the other. Currently only 13 per cent of the vision-corrected population are ‘dual wearers’ using both forms of correction and a tiny 6 per cent are ‘triple wearers’ who also have sunglasses.4 A combination of vision correction methods not only offers patients solutions to meet all their needs but has huge potential for your practice and its success.
What to look and listen for
Our best recommendations come from personalised advice. Identify something specific and relevant to the patient that could be helped by wearing contact lenses. First, probe their lifestyle, hobbies and occupation. Think of the limitations of spectacle correction for the presbyopic electrician trying to see up close while looking upwards, or the ‘weather’ benefits of contact lenses for the golfer. Second, identify ‘defining moments’ in patients’ lives such as changing schools, going to college or university, starting work or getting married, when they might benefit.
[CaptionComponent="185"]Look for clues in the patient’s appearance. Simply observing how they behave and what they are wearing can tell you a lot about their lifestyle.
Listen for complaints about ‘glasses slipping’, ‘dents in noses’, ‘always being aware of the frames’, and familiar comments such as: ‘It’s annoying having to put them on’ or ‘I’m forever losing my glasses’. The patient who takes forever to choose spectacles because ‘nothing looks right’ or ‘I just don’t like wearing glasses’ is crying out for an alternative.
Remember that part-time contact lens wear is prevalent, with 40 per cent of wearers using lenses fewer than five days a week and 74 per cent using them for less than a full day’s wear.4,5 Consider asking: ‘When do you find your glasses a nuisance/frustrating?’ or ‘Are there times when your glasses don’t work as well as you’d like?’ to identify real situations where you can help. Going out on a first date and leaving off the spectacles you usually wear, or a romantic meal in a dimly lit restaurant interrupted when you have to delve into your bag for reading glasses, are classic examples.
Once you’ve established rapport, discussion about lifestyle and current satisfaction with spectacles becomes more of an honest, open conversation. You may have often tried the: ‘Have you ever thought about contact lenses?’ or ‘Would you like to try contact lenses?’ question. But a reflex answer is generally ‘no’. A discussion in context, with a real benefit tailored to that individual, will often lead to a different outcome.
For example: ‘I know you’re a keen cyclist and I’m guessing there are times when you’re out in the rain when glasses are a real pain. Contact lenses would really enhance your enjoyment of cycling and would mean you could wear high-performance, lightweight sunglasses too.’
What to say and do
To succeed with getting potential wearers to have a contact lens trial it is important for us to address any barriers that may be present. Barriers may originate from the practice itself, from eye care practitioners, support staff, the patient or a combination of these.
[CaptionComponent="186"]Does the outside world even know you provide contact lenses? Most practices are still viewed by patients as ‘spectacle shops’, having display upon display of frames and a much smaller space, if any, dedicated to contact lenses. Make sure you provide visual prompts about contact lenses throughout the practice, from window displays and posters to leaflets and information on your website. Consider making the contact lens teach area visible too.
Try the touch and feel test
Fear of touching the eye is the greatest barrier to contact lenses among considerers and ease of handling is the factor that would most encourage lens wear.6 ‘I couldn’t put something in my eye’, ‘That’s bound to hurt’, ‘What if it gets lost?’ and ‘I couldn’t be bothered’ are familiar phrases we often hear. A brilliant way to overcome these barriers to start the patient’s journey is to say, ‘Let me show you how soft a contact lens feels’ then give them a lens to touch.
To get the whole practice team on board, display a small bowl of diagnostic lenses on the reception desk, or have support staff carry lenses in their pockets ready to show patients when discussing contact lenses.
The EASE (Enhancing the Approach to Selecting Eyewear) study3 demonstrated the benefit of offering patients contact lenses to help choose their glasses, such as asking: ‘Can I help you see more clearly while choosing your frames?’ Those offered contact lenses had a 2.5X higher purchase rate for contact lenses and spent more on their spectacles too.
Counter the cost question
The question ‘How much are they?’ is often uttered pretty soon after opening a discussion on contact lenses. Let’s not forget that it is human nature to want to feel intelligent in a conversation. The average patient may know nothing about contact lenses and, to them, one lens is no different to the next. Cost is one question that the patient can ‘sensibly’ ask, even if everything else is alien.
In fact contact lens wearers are far less likely to be driven by cost in their purchasing decisions than by health and value.7 Very few contact lens wearers (2 per cent) see value as related only to price.8 Emphasise that you will be ‘looking after’ or ‘taking care of’ their eyes or ‘offer a complete eye care service’. Discuss specific health benefits, such as a fresh, new lens every day, helping to protect against UV, and surfaces that allow the eyelid to travel smoothly over the lens, to demonstrate added value.
It is our role to educate patients on the differences to make them feel competent, such as saying: ‘Let me talk you through the suitable options and we can discuss their value as we go’. A good way to deal with an initial price query is to compare the daily cost with something they buy without thinking, such as a coffee at work or a bottle of water, to put the cost in context.
Make staff your first contact
Front of house staff are often the first point of call for patients so they need to be confident in discussing contact lenses. Simple changes can be easily implemented, such as when booking appointments asking: ‘Would you like an eye examination, contact lens consultation or both?’ or, when dispensing an external prescription, ‘Are you a contact lens wearer alongside your spectacles?’
Train staff on the benefits of contact lenses in different circumstances, the different modalities and prescription suitability. Being able to confidently discuss the basics with patients is empowering and avoids the potential for ‘I’ll have to check if we can get those in your prescription’, which immediately creates the impression that fitting them isn’t going to be easy. Try ‘We have many options available here, and I’m happy to answer your initial questions’.
Overcome comfort concerns
Comfort is a key concern among potential contact lens wearers.6 An examples for countering this in the consulting room might be: ‘I’ll be gently touching your eyelashes to help with applying the lens and it may feel a little wet or cool initially’. For some patients, try: ‘When I apply the lens there’s a slight initial awareness as your eye gets settled and your lid gets used to having to travel over the lens surface.’
Once you have got the patient interested, the next stage is the trial itself and this will often be the first time a patient has ever experienced the sensation of a contact lens. The language we use here will significantly influence the experience on both sides. ‘Insertion’ sounds invasive, ‘holding on to your lids’ suggests a struggle is imminent, and ‘foreign body sensation’ is a sure way to instil nervous anticipation.
Instead, think about more gentle expressions such as ‘applying’ the lens or ‘placing it on’. Make sure your language is positive and engages emotionally by using words such as freedom, confidence, comfort, convenience and appearance.
Delve into dropout
If they have worn contact lenses at some stage but dropped out, delve deeper. Is the patient a genuine lapsed wearer or was it an unsuccessful trial? Why did they drop out? Confident conversations with these patients about advances in materials and designs, new modalities and improvements in comfort and handling may open the door for a re-trial.
Explain that visual performance with modern contact lenses is similar to that with glasses but with the added benefits of ‘all-round vision’ and, for presbyopes, no dependence on direction of gaze. This is your opportunity to encourage their interest and dispel the misconceptions that surround contact lens wear, many of which are simply due to lack of knowledge or misinformation.
Using analogies can prove invaluable for demonstrating how contact lenses have advanced, with lenses that are more comfortable, more ‘breathable’, provide better vision and help protect against harmful UV rays, and explaining the differences between lens types. Smart phones are among the analogies that work well when describing how technology has moved on and the advantages of having the latest lenses, such as ‘If you were buying an iPhone which one would you get?’
Conclusion
Contact lenses have undergone tremendous technological improvements over the past decade, all of which have gone unnoticed among non-contact lens wearers. We simply can’t expect our patients to have an understanding of this area of our practice.
The decision to drive contact lens recommendation, find those potential new wearers and guide them into the contact lens world is one that is very much our choice and is a service we should be providing for our patients. It’s up to us to find the right words and actions to get the message across.
Think again about those patients with whom you are not currently having a contact lens conversation. The next time those three types of patient walk through your door, try using our tips for talking about contact lenses and see how many you can help to become wearers. Good luck!
The next part of our series will look at conversations with new contact lens wearers during that crucial time: the first 30 days of contact lens wear.
References
1 Ewbank A. Who fits contact lenses? Part two. Optician 2009;237:6204 16-21.
2 JJVC data on file. Shopper Segmentation Study 2012, CL considerers.
3 Atkins NP, Morgan SL and Morgan PB. Enhancing the Approach to Selecting Eyewear (EASE): A multicentre, practice-based study into the effect of applying contact lenses prior to dispensing. Cont Lens Ant Eye 2009;32:3 103-107.
4 JJVC data on file. AMR Incidence Study 2011, UK.
5 JJVC data on file. AMR Incidence Survey 2011, 8 markets across Europe, and Russia and Saudi Arabia.
6 Ruston D, Sencer S, Holmes N et al. Contemporary insights to increase contact lens penetration. Poster at British Contact Lens Association Clinical Conference 2012.
7 Aslam A. Contact lenses and spectacles: a winning combination. Optician 2013; 246:6425 26-28.
8 Aslam A, Sulley A and Packe R. Understanding the motivation of contact lens and spectacle wearers when purchasing vision correction. British Contact Lens Association Clinical Conference Poster Presentation. 2014.
Acknowledgement: Images courtesy of The Vision Care Institute.
Optometrist Clair Bulpin is in independent practice in Gloucestershire, and is an examiner and assessor for the College of Optometrists. Theresa Cox is an optometrist and pre-reg supervisor at Boots Opticians in Northwich, Cheshire. Both are Faculty members at The Vision Care Institute UK of Johnson & Johnson Medical